IVF Pregnancy Outcome Research Articles

Impact of Uterine Adenomyosis on Pregnancy Outcomes in Women Undergoing In Vitro Fertilization Treated With a Long-Term Pituitary Downregulation Protocol

BackgroundSome studies have demonstrated that adenomyosis patients can achieve a comparable pregnancy outcome with women with normal uteruses, while there is no unanimous conclusion at present.MethodWe recruited 65 adenomyosis patients and 260 frequency-matched control women with endometriosis at a ratio of 1:4 according to age. Clinical pregnancy rate, spontaneous abortion rate, and live birth rate were compared between these two groups after controlling other factors.ResultsCompared with endometriosis patients, adenomyosis patients had a higher antral follicle count (AFC) (12.71 vs 11.65, P=0.027). Though the two groups had the same number of embryos transferred, adenomyosis patients had an obviously declined implantation rate (31.91% vs 46.74%, P=0.005), clinical pregnancy rate (47.06% vs 64.42%, P=0.028), live birth rate (31.37% vs 54.81%, P=0.004), and significantly increased spontaneous abortion rate (33.33% vs 13.43%, P=0.034). Multivariate logistic regression analysis showed that adenomyosis had adverse influences on pregnancy outcome when age and the number of embryo transfers were controlled (adjusted OR=0.361, P=0.003).ConclusionEven after being matched with age, adenomyosis still had adverse influences on the pregnancy outcome of IVF in patients undergoing the long protocol.

P–194 Impact of cryopreservation duration on pregnancy outcomes of vitrified-warmed blastocysts transfer using an open-device system

Abstract Study question Is there a negative effect of long-term cryopreservation upon pregnancy outcomes after transfer of vitrified-warmed blastocysts stored in an open-device system? Summary answer Prolonged cryopreservation of vitrified blastocysts up to 24 months increased the incidences of clinical pregnancy, ongoing pregnancy, and live birth, while decreased early miscarriage rate. What is known already Vitrification is adopted as the dominant approach for cryopreservation of human oocytes and embryos. However, little is known about the potential effect of prolonged storage after vitrification on the genomic integrity and metabolism of embryos. Several studies have sought to decipher the effect of cryopreservation duration on IVF pregnancy outcomes, but few were confined to vitrification and the results were inconsistent. Study design, size, duration This retrospective study included 6722 patients undergoing their first vitrified-warmed blastocyst transfer (VBT) cycles from January 2015 to June 2019 in a single fertility center in South China. The study was approved by the hospital’s Ethics Committee. Participants/materials, setting, methods A total of 6722 eligible patients were divided into five groups according to the storage duration after vitrification: Group I: 0–3 months; Group II: 3–6 months; Group III: 6–12 months; Group IV: 12–24 months; Group V: 24–36 months. The IVF pregnancy outcomes were compared between groups. Multivariate logistic regression was conducted to evaluate the independent effect of storage duration on pregnancy outcomes. Main results and the role of chance The odds of clinical pregnancy outcomes were similar from Group 1 to 4. However, the chance of clinical pregnancy (Group 1 as reference; Group 2: adjusted odds ratio (aOR)= 1.04, 95% CI 0.93–1.17; Group 3: aOR = 1.02, 95% CI 0.84–1.25; Group 4: aOR = 0.93, 95% CI 0.66–1.31; Group 5: aOR = 0.54, 95% CI 0.38–0.76) , ongoing pregnancy (Group 2: aOR=0.99, 95% CI 0.89–1.11; Group 3: aOR = 0.94, 95% CI 0.77–1.14; Group 4: aOR = 0.87, 95% CI 0.62–1.22; Group 5: aOR = 0.41, 95% CI 0.29–0.60), and live birth rate (Group 2: aOR=1.00, 95% CI 0.89–1.12; Group 3: aOR = 0.98, 95% CI 0.81–1.19; Group 4: aOR = 0.91, 95% CI 0.65–1.27; Group 5: aOR = 0.46, 95% CI 0.32–0.66) significantly decreased, while the early miscarriage rate (Group 2: aOR=1.11, 95% CI 0.92–1.35; Group 3: aOR =1.25, 95% CI 0.92–1.70; Group 4: aOR = 1.33, 95% CI 0.77–2.31; Group 5: aOR = 2.42, 95% CI 1.36–4.31) significantly increased as the storage duration increased up to 24–36 months. Limitations, reasons for caution The primary limitation of this study was its retrospective nature. Besides, as all these data come from a single IVF treatment center, the results should be confirmed by a larger multicenter study. Wider implications of the findings: Our study provides more evidence about the negative impact of long-term storage of vitrified embryos on the clinical outcome. Clinicians should adapt FET strategies based on the embryo storage duration. Trial registration number Not applicable

Placenta accreta spectrum disorders in pregnancies following in vitrofertilization

Placenta previa and related pregnancy complications are more common in In vitro fertilization pregnancies compared with spontaneous ones. There is evidence that PAS disorders are more common in pregnancies after IVF. Factors leading to a higher incidence of this pathology in IVF pregnancies have not been fully studied. Possible causes are the advanced age of women undergoing IVF, factors related to infertility itself, causes from the biological part of the In vitro procedure or controlled ovarian stimulation. The study of these factors is crucial for clinical practice as it would improve the outcome of IVF pregnancies.

PROGNOSTIC VALUE OF LOW ANTI-MULLERIAN HORMONE LEVEL DURING IVF AMONG YOUNG WOMEN: A SART CORS STUDY

Diminished ovarian reserve (DOR) describes women of reproductive age whose response to ovarian stimulation or fecundity is reduced as compared to women of similar age group. Lower anti-mullerian hormone (AMH) level has been associated with, but not necessarily predict, poor responses to ovarian stimulation, poor embryo quality, an poor pregnancy outcome in IVF. However, there are no useful threshold for critical clinical decision making. Studies have shown that lower AMH in combination with advanced maternal age indicates poor IVF outcome.

OUTCOMES AFTER ADJUNCT GROWTH HORMONE TREATMENT WITH A LOW, INTERMEDIATE, OR HIGH DOSE PROTOCOL IN IVF CYCLES WITH POOR RESPONDERS

Adjunct growth hormone (GH) is used in poor responders to improve IVF cycle and pregnancy outcomes. There is no consensus on the ideal GH protocol. We compared the extended low, intermediate, and high dose GH protocols used at our center to determine if there was a difference in IVF and pregnancy outcomes.

BLACK RACE RESULTS IN LOWER LIVE BIRTH RATE (LBR) IN FROZEN-THAWED BLASTOCYST TRANSFER CYCLES (FET): AN ANALYSIS OF 7,002 SART FET CYCLES

Previous studies of fresh IVF cycles demonstrate lower pregnancy rates in black compared to white women, whereas a small FET study from a single site showed comparable pregnancy rates (1). We examined if racial disparities in IVF pregnancy outcomes persisted in FET cycles on a national level.

Delay in IVF treatment up to 180 days does not affect pregnancy outcomes in women with diminished ovarian reserve.

STUDY QUESTIONWill a delay in initiating IVF treatment affect pregnancy outcomes in infertile women with diminished ovarian reserve?SUMMARY ANSWERA delay in IVF treatment up to 180 days does not affect the live birth rate for women with diminished ovarian reserve when compared to women who initiate IVF treatment within 90 days of presentation.WHAT IS KNOWN ALREADYIn clinical practice, treatment delays can occur due to medical, logistical or financial reasons. Over a period of years, a gradual decline in ovarian reserve occurs which can result in declining outcomes in response to IVF treatment over time. There is disagreement among reproductive endocrinologists about whether delaying IVF treatment for a few months can negatively affect patient outcomes.STUDY DESIGN, SIZE, DURATIONA retrospective cohort study of infertile patients in an academic hospital setting with diminished ovarian reserve who started an IVF cycle within 180 days of their initial consultation and underwent an oocyte retrieval with planned fresh embryo transfer between 1 January 2012 and 31 December 2018.PARTICIPANTS/MATERIALS, SETTING, METHODSDiminished ovarian reserve was defined as an anti-Müllerian hormone (AMH) <1.1 ng/ml. In total, 1790 patients met inclusion criteria (1115 immediate and 675 delayed treatment). Each patient had one included cycle and no subsequent data from additional frozen embryo transfer cycles were included. Since all cycle outcomes evaluated were from fresh embryo transfers, no genetically tested embryos were included. Patients were grouped by whether their cycle started 1–90 days after presentation (immediate) or 91–180 days (delayed). The primary outcome was live birth (≥24 weeks of gestation). A subgroup analysis of more severe forms of diminished ovarian reserve was performed to evaluate outcomes for patients with an AMH <0.5 and for patients >40 years old with an AMH <1.1 ng/ml (Bologna criteria for diminished ovarian reserve). Logistic regression analysis, adjusted a priori for patient age, was used to estimate the odds ratio (OR) with a 95% CI. All pregnancy outcomes were additionally adjusted for the number of embryos transferred.MAIN RESULTS AND THE ROLE OF CHANCEThe mean ± SD number of days from presentation to IVF start was 50.5 ± 21.9 (immediate) and 128.8 ± 25.9 (delayed). After embryo transfer, the live birth rate was similar between groups (immediate: 23.9%; delayed: 25.6%; OR 1.08, 95% CI 0.85–1.38). Additionally, a similar live birth rate was observed in a subgroup analysis of patients with an AMH <0.5 ng/ml (immediate: 18.8%; delayed: 19.1%; OR 0.99, 95% CI 0.65–1.51) and in patients >40 years old with an AMH <1.1 ng/ml (immediate: 12.3%; delayed: 14.7%; OR 1.21, 95% CI 0.77–1.91).LIMITATIONS, REASONS FOR CAUTIONThere is the potential for selection bias with regard to the patients who started their IVF cycle within 90 days compared to 91–180 days after initial consultation. In addition, we did not include patients who were seen for initial evaluation but did not progress to IVF treatment with oocyte retrieval; therefore, our results should only be applied to patients with diminished ovarian reserve who complete an IVF cycle. Finally, since we excluded patients who started their IVF cycle greater than 180 days from their first visit, it is not known how such a delay in treatment affects pregnancy outcomes in IVF cycles.WIDER IMPLICATIONS OF THE FINDINGSA delay in initiating IVF treatment in patients with diminished ovarian reserve up to 180 days from the initial visit does not affect pregnancy outcomes. This observation remains true for patients who are in the high-risk categories for poor response to ovarian stimulation. Providers and patients should be reassured that when a short-term treatment delay is deemed necessary for medical, logistic or financial reasons, treatment outcomes will not be affected.STUDY FUNDING/COMPETING INTEREST(S)No financial support, funding or services were obtained for this study. The authors do not report any potential conflicts of interest.TRIAL REGISTRATION NUMBERNot applicable.

Protein Expression Profile in IVF Follicular Fluid and Pregnancy Outcome Analysis in Euthyroid Women with Thyroid Autoimmunity.

The objective of this study is to investigate the influence of the thyroid autoantibodies on the protein expression in follicular fluid and the clinical outcome of assisted reproductive technology. A total of 602 patients treated for infertility were screened; 49 euthyroid women who were positive for thyroid autoantibodies and 63 negative controls were recruited. Follicular fluid samples were analyzed using proteomics. Validation of target proteins in follicular fluid was performed by using parallel reaction monitoring. Differentially expressed proteins in follicular fluid, clinical pregnancy rate, abortion rate, and live-birth rate were analyzed. Clinical pregnancy rates and take-home baby rates in the thyroid autoimmunity (TAI) group were less than in the control group, but abortion rates in the TAI group were higher than in the control group (all P < 0.005). A total of 49 proteins were differentially expressed in the TAI-positive group. In Gene Ontology secondary annotations of all the proteins identified, five types of proteins were associated with the reproductive process. Among 11 proteins quantitatively identified by parallel reaction monitoring, angiotensinogen and fetuin-B were associated with reproduction. These differentially expressed proteins identified in this study involved multiple pathways according to the Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. Our study provides evidence that some differentially expressed proteins between TAI-positive women and controls were associated with the reproductive process and closely related to important physiologic effects, which could partially explain the underlying mechanism link between TAI and the adverse outcomes of assisted reproductive technology.

Impact of maternal ethnicity on pregnancy outcome in infertile women with polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is the most prevalent endocrine pathology seen among women of reproductive age. The objective of the study is to investigate the impact that ethnic background has on pregnancy outcomes, including live birth rates in infertile women with PCOS going through IVF compared to women without PCOS. Retrospective cohort study in an academic IVF center. This study used a coded REDCap data set of 486 women, 18-45 years of age who underwent IVF and embryo transfer between 1/1/2010 and 12/31/2015 at an academic IVF Center after IRB approval (IRB 2015-0623). Patients underwent their 1st IVF cycle following progestogen withdrawal (norethindrone acetate) using GnRH agonist or antagonist protocols with mixed gonadotropins and demographic data, including race and ethnicity was obtained. Data collected during the IVF process included peak estradiol, number of mature oocytes, fertilization rate, number of top quality embryos on Day 3 of development, number of embryos transferred, implantation rate, clinical pregnancy rate, live birth rate, clinical miscarriage rate, and ectopic pregnancy rate. In women, whose pregnancy resulted in a live birth, additional maternal and neonatal variables were collected, including estimated gestational age (EGA) at delivery, mode of delivery, and weight at birth. Using R analytics software, data was analyzed using logistic regression and linear models. For logistic regression, the estimated coefficient was the log-odds-ratio. A significant p value was considered <0.05. Of the 486 initial women, 360 women were included in the final analysis. Only women with known/reported ethnicity were included. Not Hispanic is the referent cohort for ethnicity and non-PCOS is the referent group when comparing PCOS status. There was no significant difference found for implantation rate (p=0.53) and pregnancy rate (p=0.99) when comparing women without PCOs with the women with PCOS. When taking into account the ethnicity factor in PCOS and the women who conceived and had a live birth, there was no significant difference between being Hispanic with PCOs and the referent non-Hispanic group. However, when evaluating women who started the IVF cycle, women with PCOS are less likely to have a pregnancy that leads to a live birth compared to women without PCOS (p=0.046). Being Hispanic by itself does not seem to affect live birth (p= 0.81). Hispanic women with PCOS have the same probability of having a vaginal delivery compared to the referent group (p=0.935). Women with PCOS are more likely to deliver ∼2 weeks earlier than non-PCOS patients (p=0.038). Being Hispanic and having PCOS did not affect the EGA at delivery (p= 0.83) or affected fetal weight compared to the referent group (p=0.58). This pilot study did not find a significant difference in most of the variables studied comparing Hispanic PCOS women with non-Hispanic women without PCOS. However, further studies with a larger number of subjects are needed to assess the impact of ethnicity and PCOS on IVF pregnancy outcomes.

Value of endometrial echo pattern transformation after hCG trigger in predicting IVF pregnancy outcome: a prospective cohort study

Value of endometrial echo pattern transformation after hCG trigger in predicting IVF pregnancy outcome: a prospective cohort study

Reducing size of transfer syringe is beneficial for IVF pregnancy outcomes

Reducing size of transfer syringe is beneficial for IVF pregnancy outcomes

Management of thin endometrium in assisted reproduction: a clinical practice guideline from the Canadian Fertility and Andrology Society.

The impact and management of thin endometrium is a common challenge for patients undergoing assisted reproduction. The objective of this Canadian Fertility and Andrology Society (CFAS) guideline is to provide evidence-based recommendations using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework on the assessment, impact and management of thin endometrium in assisted reproduction. The effect of endometrial thickness on pregnancy and live birth outcomes in ovarian stimulation and IVF (fresh and frozen cycles) is addressed. In addition, recommendations on the use of adjuvants to improve endometrial thickness and pregnancy outcomes are provided.

The relationship between vitamin D and IVF: a systematic review and meta-analysis

Vitamin D deficiency does not influence IVF outcomes, but is related to lower pregnancy and it is important to provide more reliable evidence on vitamin D in IVF due o the published studies which are strongly contradictory. Objectives: To explore the effect of vitamin D in IVF with a focus on the outcome of clinical pregnancy in published studies. Materials and Methods: The authors used PubMed, EMBASE, Web of knowledge (SCI), and Cochrane Library Methods to explore all studies that evaluate vitamin D levels and IVF outcomes until 2016. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for analyses. Result: The authors first classified two groups to investigate the influence of vitamin D in IVF. There was no significant difference with deficient vitamin D and IVF outcome (RR 0.88, 95% CI 0.74-1.04; I2 63%, seven trials; 1,865 participants). In addition, vitamin D deficiency also di not show a significant difference in IVF outcome (RR 0.91, 95 % CI 0.77-1.18, RR 0.91, 95% CI, 0.77-1.18; I2, 72 trials, 1,172 participants). Conclusion: There is no significance between vitamin D status (deficiency or replete) and IVF outcomes, but it was also found that vitamin D deficiency was inclined to lower IVF pregnancy outcome.

A cost-effectiveness analysis of freeze-only or fresh embryo transfer in IVF of non-PCOS women

Is a freeze-only strategy more cost-effective from a patient perspective than fresh embryo transfer (ET) after one completed In Vitro Fertilization/ Intracytoplasmic Sperm Injection (IVF/ICSI) cycle in women without polycystic ovary syndrome (PCOS)? There is a low probability of the freeze-only strategy being cost-effective over the fresh ET strategy for non-PCOS women undergoing IVF/ICSI. Conventionally, IVF embryos are transferred in the same cycle in which oocytes are collected, while any remaining embryos are frozen and stored. We recently evaluated the effectiveness of a freeze-only strategy compared with a fresh ET strategy in a randomized controlled trial (RCT). There was no difference in live birth rate between the two strategies. A cost-effectiveness analysis (CEA) was performed alongside the RCT to compare a freeze-only strategy with a fresh ET strategy in non-PCOS women undergoing IVF/ICSI. The effectiveness measure for the CEA was the live birth rate. Data on the IVF procedure, pregnancy outcomes and complications were collected from chart review; additional information was obtained using patient questionnaires, by telephone. For all patients, we measured the direct medical costs relating to treatment (cryopreservation, pregnancy follow-up, delivery), direct non-medical costs (travel, accommodation) and indirect costs (income lost). The direct cost data were calculated from resources obtained from patient records and prices were applied based on a micro-costing approach. Indirect costs were calculated based on responses to the questionnaire. Patients were followed until all embryos obtained from a single controlled ovarian hyperstimulation cycle were used or a live birth was achieved. The incremental cost-effectiveness ratio (ICER) was based on the incremental cost per couple and the incremental live birth rate of the freeze-only strategy compared with the fresh ET strategy. Probabilistic sensitivity analysis (PSA) and a cost-effectiveness acceptability curve (CEAC) were also performed. Between June 2015 and April 2016, 782 couples were randomized to a freeze-only (n = 391) or a fresh ET strategy (n = 391). Baseline characteristics including mean age, Body Mass Index (BMI), anti-Mullerian hormone, total dose of Follicle Stimulating Hormone (FSH), number of oocytes obtained, good quality Day 3 embryos, fertility outcomes and treatment complications were comparable between the two groups. The live birth rate (48.6% vs. 47.3%, respectively; risk ratio, 1.03; 95% Confidence Interval [CI], 0.89, 1.19; P = 0.78) and the average cost per couple (3906 vs. 3512 EUR, respectively; absolute difference 393.6, 95% CI, -76.2, 863.5; P = 0.1) were similar in the freeze-only group versus fresh ET. Corresponding costs per live birth were 8037 EUR versus 7425 EUR in the freeze-only versus fresh ET group, respectively. The incremental cost for the freeze-only strategy compared with fresh ET was 30 997 EUR per 1% additional live birth rate. The direct non-medical costs and indirect costs of infertility treatment strategies represented ~45-52% of the total cost. PSA shows that the 95% CI of ICERs was -263 901 to 286 681 EUR. Out of 1000 simulations, 44% resulted in negative ICERs, including 13.0% of simulations in which the freeze-only strategy was dominant (more effective and less costly than fresh ET), and 31% of simulations in which the fresh embryo strategy was dominant. In the other 560 simulations with positive ICERs, the 95% CI of ICERs ranged from 2155 to 471 578 EUR. The CEAC shows that at a willingness to pay threshold of 300 000 EUR, the probability of the freeze-only strategy being cost-effective over the fresh ET strategy would be 58%. Data were collected from a single private IVF center study in Vietnam where there is no public or insurance funding of IVF. Unit costs obtained might not be representative of other settings. Data obtained from secondary sources (medical records, financial and activity reports) could lack authenticity, and recall bias may have influenced questionnaire responses on which direct costs were based. In non-PCOS women undergoing IVF/ICSI, the results suggested that the freeze-only strategy was not cost-effective compared with fresh ET from a patient perspective. These findings indicate that other factors could be more important in deciding whether to use a freeze-only versus fresh ET strategy in this patient group. This study was funded by My Duc Hospital; no external funding was received. Ben Willem J. Mol is supported by an NHMRC Practioner Fellowship (GNT 1082548) and reports consultancy for Merck, ObsEva and Guerbet. Robert J. Norman has shares in an IVF company and has received support from Merck and Ferring. All other authors have no conflicts of interest to declare. Not applicable.

How Important Is Early Diagnosis and Intense Insulin Therapy in In Vitro Fertilization Pregnancies Complicated by Gestational Diabetes Mellitus?

GDM is increased in IVF pregnancies. There is limited literature on GDM screening and management of IVF pregnancies. The aim was to investigate the impact of GDM management on the outcome of IVF pregnancies. The study was conducted with 102 singleton IVF (a), 102 GDM spontaneous conceptions (b) vs. 102 normal pregnancies (c). The group characteristics: [age: 38.2±4 vs. 34.1±3 vs. 37.4±5 years, p&amp;lt;0.001 (a vs. b), NS (a vs. c), &amp;lt;0.001 (b vs. c); BMI: 25.8±5 vs. 23±4 vs. 22.7±4 kg/m2, p&amp;lt;0.001 (a vs. b), &amp;lt;0.001 (a vs. c), NS (b vs. c); HbA1c: 5.2±0.5 vs. 5.2±0.7 vs. 4.7±0.3%, p=NS (a vs. b), &amp;lt;0.001 (a vs. c), &amp;lt;0.001 (b vs. c); FBG: 84.1±8.4 vs. 84.2±7.1 vs. 78.2±5.2 mg/dl, p=NS (a vs. b), &amp;lt;0.001 (a vs. c), &amp;lt;0.001 (b vs. c); 1-hour postprandial BG: 103.6±11 vs. 106.5±10 mg/dl, p=NS (a vs. b); week of diagnosis GDM: 21.8±5.2 vs. 23.8±6.2, p=0.03 (a vs. b); week of starting insulin: 22.8±5 vs. 24.8±5, p=0.03 (a vs. b)].The obstetric and neonatal history are: Maternal weight gain: 10.4±4 vs. 11.9±3 vs. 10.5±2kg, p=0.035 (a vs. b), p=NS (a vs. c), p=0.03 (b vs. c); week. of delivery: 36.9±2 vs. 37.4±0.7 vs. 38.1±0.8, p=0.04 (a vs. b), p&amp;lt;0.001 (a vs. c), p&amp;lt;0.001 (b vs. c); neonatal birth wt.: 2857±517 vs. 2891±341 vs. 3117±347g, p=NS (a vs. b), p&amp;lt;0.001 (a vs. c), p&amp;lt;0.001 (b vs. c); preeclampsia rate: 4.9 vs. 3.9 vs. 1.9%; Respiratory Distress Syndrome: 14.7 vs. 12 vs. 5.8%; Neonatal hypoglycemia: 17.6 vs. 14.7 vs. 3.9%, NICU admits: 14.7 vs. 15.6 vs. 5.8%, C-Section: 86.3 vs. 56.9 vs. 41.1%. Associations between characteristics and adverse outcomes were tested among the IVF group. 1-hour Postprandial BG, but not FBG nor HbA1c, was associated with maternal-fetal complications (r=0.504, p&amp;lt;0.001). Maternal hypoglycemia did not affect fetal outcome. Age and BMI were not correlated with the week of GDM diagnosis. The data emphasizes the importance of strict postprandial metabolic control reached by intense early insulin therapy limiting the incidence of adverse pregnancy outcomes. IVF pregnancies must be screened for GDM much earlier than 24-28 weeks. Disclosure P. Thomakos: None. O. Kepaptsoglou: None. A. Trouva: None. C. Baretto: None. D. Trouvas: None. I. Taraoune: None. A. Korantzis: None. C. Zoupas: None.

Clinical efficacy and mechanism of growth hormone action in patients experiencing repeat implantation failure.

The objectives of this study were to investigate the clinical efficacy of growth hormone (GH) in patients experiencing repeat implantation failure (RIF) and explore the possible mechanism. Forty-two RIF patients undergoing in vitro fertilization - embryo transfer (IVF-ET) were enrolled in the present trial: 22 patients who received GH (treatment group) and 20 who did not receive GH (controls). The clinical pregnancy and live birth rates in the treatment group were significantly higher than those in the control group (both P < 0.05). The treatment group expressed significantly higher levels of growth hormone receptor (GHR) mRNA than the control group (P < 0.05). Further analysis showed that GH levels in follicular fluid were positively correlated with the expression levels of mRNA encoding GHR in granulosa cells (r = 0.460, P < 0.05). GH treatment enhanced IVF pregnancy outcomes and increased the expression of GHR in granulosa cells in fluid. GH levels in follicular fluid were positively correlated with the expression levels of GHR.

Impact of late-follicular phase elevated serum progesterone on cumulative live birth rates: is there a deleterious effect on embryo quality?

Is elevated late-follicular phase progesterone (EP) associated with a deleterious impact on embryo quality (EQ) and cumulative live birth rates (LBRs)? EP was associated with a decrease in embryo utilization and cumulative LBRs. Ovarian stimulation promotes the production of progesterone (P) which adversely affects IVF pregnancy outcomes. However, evidence regarding a potential association between EP an EQ is lacking. A retrospective analysis of all GnRH antagonist down-regulated ICSI cycles followed by a fresh embryo transfer (ET) between 2010 and 2015 was performed. The sample was stratified according to the following P levels on the day of ovulation triggering: ≤0.50, 0.51-1.49 and ≥1.50 ng/ml. The primary outcomes were embryo utilization rates (number of embryos transferred or cryopreserved) and cumulative LBR, defined as the occurrence of the first live-birth after either the fresh or one of the subsequent frozen ET. Overall, 3400 cycles were included in the analysis, using multivariable regression to account for potential confounding. Female age and the number of oocytes retrieved increased significantly with increasing serum P values. Utilization rates decreased linearly as P increased for Day 3 embryos (72.3, 63.0 and 45.4%, respectively), while for Day 5 embryos only the EP group was associated with a significant decrease (48.8, 47.8 and 38.8%, respectively). EP was also associated with decreased fresh and cumulative LBRs. The main limitations of this study were its retrospective nature and the fact that it was restricted to GnRH antagonist cycles. These results raise the question whether EP may also be associated with a decrease in cumulative pregnancy outcomes by increasing embryo wastage. Further studies may evaluate the potential benefit of additional measures besides the freeze-all strategy to avoid this issue, such as lowering the stimulation dose or applying a step-down protocol. None.

Effect of Mucous, Blood and Bacterial Contamination at the Time of Embryo Transfer, and it's Impact on the IVF Pregnancy Outcome

The aim of this study is to investigate whether the presence of mucous, blood and microorganisms, as detected on catheters used for ET alters the outcome of IVF-ET.

Oliver Sacks: Our Correspondence About Twins/Twin Research: Vanishing Twins Syndrome; Discordant Sex in MZ Twins; Pregnancy Outcomes in IVF and ICSI Conceived Twins/Print and Media: Superfetated Twins; Twins Discordant for Smoking; Twins in Fashion; Yale University Twin Hockey Players; Conjoined Twin-Visiting Professor.

The late neurologist and author, Oliver Sacks, published an insightful 1986 review of Marjorie Wallace's book, The Silent Twins, in the New York Times. Taking exception to his assertion about Sir Francis Galton, I wrote a letter to the Times' editor. The letter was unpublished, but it brought a wonderful response from Sacks himself that is reproduced and examined. Next, brief reviews of twin research concerning the vanishing twin syndrome (VTS), discordant sex in a monozygotic (MZ) twin pair, and multiple pregnancy outcomes from assisted reproductive technology (ART) are presented. This section is followed by popular coverage of superfetated twins, smoking-discordant co-twins, twins in fashion, Yale University twin hockey players, and a visiting professor who was a conjoined twin.

Pregnancy, Delivery, and Neonatal Outcomes of In Vitro Fertilization-Embryo Transfer in Patient with Previous Cesarean Scar.

BackgroundWhat role should previous cesarean section play in affecting clinical pregnancy outcomes and avoiding the complications of in vitro fertilization? In this article, we focus on elective single-embryo transfer (eSET) versus double-embryo transfer (DET) and assess the clinical efficacy and safety of eSET in patients who have a previous cesarean scar.Material/MethodsThe pregnancy, delivery, and neonatal outcomes of 130 patients who had a previous cesarean scar and received in vitro fertilization-embryo transfer (IVF-ET) were retrospectively analyzed. The number of transferred embryos was chosen depending on patients’ desire after acknowledging all benefits and risks, including eSET (eSET group, n=56) and DET (DET group, n=74). A total of 101 patients with previous vaginal delivery receiving IVF-ET in the same period were included as a control group.ResultsThe pregnancy rates, multiple birth rates, abortion rates, ectopic pregnancy rates, gestational age at delivery, preterm birth rates, neonatal birth weight, and take-home baby rates were similar between the previous cesarean section group and the previous vaginal delivery group. A previous cesarean section scar did not affect embryo implantation and pregnancy outcomes in IVF. In the eSET and DET groups of previous cesarean section patients, the embryo implantation rates, pregnancy rates, abortion rates, and take-home baby rates were similar. However, the rate of multiple pregnancies reached 50% in the DET group, which led to more preterm births and lower birth weight.ConclusionsElective single-embryo transfer is a well-accepted strategy to avoid multiple pregnancies and improve the obstetric and neonatal outcomes of singleton pregnancy in IVF patients with a previous cesarean section.